Premature Mortality Due to Fractures in a Population-Based Prospective Cohort Study of 238,673 Older Women and Men

Lyn March¹, Weiwen Chen², Judy M Simpson³, Fiona Blyth⁴ and Jacqueline Center², ¹Department of Rheumatology, Northern Clinical School, Institute of Bone and Joint Research, Kolling Institute, University of Sydney & Department of Rheumatology, Royal North Shore Hospital, St Leonards, Sydney, Australia, ²Endocrinology, Osteoporosis & Bone Biology Garvan Institute of Medical Research, St Vincent's Clinical School, UNSW, Darlinghurst, Australia, ³Statistics, University of Sydney School of Public Health, Sydney, Australia, ⁴Concord Clinical School University of Sydney and Sax Institute, Sydney, Australia

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Data analysis, fractures, morbidity and mortality and osteoporosis

Session Information

Date: Tuesday, November 10, 2015

Title: Osteoporosis and Metabolic Bone Disease - Clinical Aspects and Pathogenesis

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Osteoporotic (OP) fractures and falls are a growing global problem
as the population ages. One third of all falls related deaths are attributable
to low bone density. Yet OP is poorly managed despite effective treatments
being available. A potential reason for not prioritizing OP treatment may be
the lack of awareness of the increased mortality due to OP fractures. The aim
of this analysis was to determine mortality risk with all fragility fractures
in community-dwelling older women and men in New South Wales, Australia.

Methods: Baseline questionnaire data from the 45 & Up Study, a
prospective population-based cohort of 238,673 older women (125,174) and men
(113,499), were linked to the Emergency Department Data Collection (EDDC),
Admitted Patient Data Collection (ADPC- including all hospital admissions,
procedures and diagnoses within NSW), Registry of Births, Marriages and Death
(RBDM). Fractures were identified
from the EDDC and ADPC using the ICD 9, 10, SNOMED and procedure codes.
Participants were followed from recruitment (2006-2008) till either death or 31
December 2013. Cox proportional hazards models calculated mortality hazard
ratios (HR) (adjusted for age, gender, Charlson
comorbidity index, prior fracture history) between those who did and did not
fracture.

Results: A total of 14,827 fractures (9,145 females (F) and 5,682 males (M))
and 15,621 deaths (5,604 F and 10,017 M) were available for analysis. The mean
age of the cohort was 63 yrs with mean follow-up of 5.7
yrs (sd:1.0). In the whole
cohort, absolute mortality rate was higher in men (15.7/1000 person yrs) than women (7.9/1000 person yrs).
Having an incident fracture increased mortality rates by ~ two-fold in both men: (33/ 1000 person yrs) and
women (19/1000 person yrs). This differed by fracture
type as demonstrated by adjusted HRs. Mortality was
increased for all proximal site but not distal fractures (See Table).

Conclusion: In a large sample of community dwelling older women and men
premature mortality risk is significantly increased following all proximal but
not distal fractures. The cause of this increased mortality needs to be
explored.

Table 1: Adjusted hazard Ratios (HR) and 95% confidence interval (CI) for
mortality risk and all fracture types for females and males

FEMALES

MALES

Site

95% CI

Hip

1477

2.58

2.30

2.89

977

3.21

2.85

3.60

Pelvis

564

2.33

1.94

2.79

295

3.28

2.63

4.07

Vertebral

599

2.32

1.88

2.87

508

2.72

2.25

3.30

Femur

259

1.91

1.40

2.60

181

2.86

2.12

3.85

Humerus

904

1.90

1.55

2.35

354

1.80

1.39

2.34

Clavicle

142

2.32

1.37

3.90

252

2.11

1.44

3.09

Tibia

279

2.81

1.51

5.22

131

3.12

2.04

4.78

Elbow

109

2.03

1.39

2.96

1.92

1.00

3.69

Knee

223

1.28

0.78

2.12

106

1.81

1.07

3.05

Forearm

137

1.28

0.67

2.47

1.30

0.91

1.88

Wrist

1787

1.15

0.91

1.44

489

1.30

0.91

1.88

Hand

204

1.3

0.68

2.51

198

1.25

0.73

2.16

Finger

266

1.49

0.80

2.77

318

0.99

0.57

1.70

Ankle

1085

1.00

0.68

1.47

472

1.29

0.89

1.87

Foot

628

0.96

0.59

1.57

236

1.17

0.64

2.14

Toe

285

0.78

0.29

2.08

157

0.95

0.36

2.53

Acknowledgements: Ideas from the late JS Charles Chen funded by USyd Rolf Edgar Lake
Fellowship & Osteoporosis Australia; WC supported by RACP & NHMRC
Scholarship; JC supported by a NHMRC Practitioner Fellowship.

Disclosure: L. March, None; W. Chen, None; J. M. Simpson, None; F. Blyth, None; J. Center, None.

To cite this abstract in AMA style:

March L, Chen W, Simpson JM, Blyth F, Center J. Premature Mortality Due to Fractures in a Population-Based Prospective Cohort Study of 238,673 Older Women and Men [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/premature-mortality-due-to-fractures-in-a-population-based-prospective-cohort-study-of-238673-older-women-and-men/. Accessed .

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